Wednesday is the day YOU get to “Ask an Attorney.” Just leave your question in the comments below, and if your question is selected, it will be answered on an upcoming Wednesday by one of our attorneys at Dean Burnetti Law.
Tammy H. from Lakeland asks “My 82-year-old father was recently hospitalized and had to have surgery that resulted in the need for him to wear a feeding tube for the rest of his life. Prior to this, my brother and I took turns looking in on Dad at his own home. Now, the doctor says he will require round-the-clock nursing care. My brother will be in a position to hire a live-in nurse for Dad in about 6 months when he gets a settlement he’s waiting on, but until then, we have to find a nursing home. Fast. What should we look for to be sure he will safe?”
Hi, Tammy. I’m so glad you’re asking this question before you search for a home for your dad. Too often, this question comes after an incident has already happened. It’s critical for you and your brother to stay actively involved and vigilant to ensure your dad receives the best possible nursing home care, so be sure to look for a facility that’s close enough that you and your brother can visit often.
Before you sign anything, you need to tour the facility. (Actually, you should tour several facilities before you settle on one.) Federal regulations overseen by the Centers for Medicare and Medicaid Services require skilled nursing facilities provide the following to all residents:
- A clean, comfortable mattress;
- A bed of appropriate size and height;
- Bedding, which is appropriate to the weather/climate;
- Furniture appropriate to the resident’s needs, including a separate closet or clothing storage spaces;
- A room with a window to the outside for natural light and orientation to the time of day, weather, and season;
- A “safe, clean, comfortable and homelike environment,” meaning it should feel less institutional and more home-like, so residents can bring items and personal effects with them to help create a meaningful and personalized living space.
Also, as soon as you step in the door of the facility, put all your senses to work:
From the moment you enter the facility, listen.
While residents moaning or calling for help might be disconcerting, it’s not necessarily a sign of mistreatment. But pay attention to how staff members address the residents. Remember, the generation going into nursing care these days came from a time when they were addressed as Mr. Smith or Mrs. Jones. If the nursing staff calls them honey, sweetie, or mama, the resident may lose dignity, and, if dementia has set in, the resident may not even be responsive.
What do you smell?
A lot of nursing homes have a certain funky smell. Oftentimes, these are unavoidable, such as when certain medications or diets make the residents gassier than normal. Plus, the aging process sometimes causes the elderly to lose control of their bladder or bowels. But, if the facility reeks of stale urine or feces, there’s a strong likelihood that it isn’t being cleaned properly, or that the residents who wear incontinence garments are not being changed as often as they should be. Worse yet, if there is an abundance of people with bedsores, the smell of infection can be overbearing.
Does the food look and taste palatable?
Even though a meal might meet a resident’s dietary requirements, if it doesn’t taste good to someone who may be losing their taste, or if it isn’t visually appealing to someone who may be losing interest in eating, that’s a red flag. While you’re observing the residents eat, pay attention to those residents who cannot feed themselves. Are they eating with their hands? Is someone taking care to feed them? Are they watching everyone else eat while they are being ignored? Is someone shoving food in their mouth and trying to hurry them up? Older people tend to eat slowly, and if the staff doesn’t have the time or manpower to help a resident eat their meal so that they can enjoy it and digest it properly, there’s a problem.
How do the residents spend their waking hours?
As you tour the facility during the daytime, take note of how many residents are still in bed. If there is a crowd of wheelchairs parked in front of the nurses’ station, while that’s still better than them being stuck in bed with only a TV to babysit them, it’s not enough. A quality facility will have a daily activity calendar for their residents (which you should be prominently displayed for you to see without having to ask). Activities might include a live music and sing-along hour in a common room, BINGO, jigsaw puzzle time, a common TV and board game room for use during unstructured times, church and worship times, a Bible study hour, visits from local youth groups, visits from various animal handlers, an exercise hour, an outdoor time, a gardening hour, a walking tour, etc. Some facilities even have a bus that transports the residents (and their caregivers) to stores or concerts once a week so they can get out.
How do the staff interact with each other?
If the staff are rude to each other, they won’t think twice about being bad-tempered with a resident. Also, if a radio or TV playing in the background isn’t tuned in for residents but is playing shows or music for a twenty-something crowd, then you’ll know those are really on for the staff and not the residents. Likewise, if a resident’s TV is tuned to a young children’s show, the staff is turning that program on and, in the process, are causing the resident to lose dignity by not allowing them to watch something they might have enjoyed when they still lived at home which was meant for adults. Finally, pay attention to how the nursing staff spends its time once all the charting and direct care has been finished for their unit. If you see a bunch of nurse’s aides grouped together giggling over something while the residents are stationed in wheelchairs looking bored, that’s a problem.
Do you notice any bruising?
Every black-and-blue mark is not necessarily a sign of abuse. As people age, their skin becomes thinner and more fragile, and certain medications make them more likely to bruise easily. However, some contusions should not be ignored. Look for a hand or fingertip shaped bruises around the wrists or upper arms. Also, any handprint-shaped marks on any body part are unlikely to be caused by an accidental fall and should be questioned.
Do you notice bedsores?
Sometimes, bedsores are unavoidable, especially as a resident becomes sicker and more immobile. However, if the resident is capable of being up and is developing bed sores, it’s important to question why he’s spending so much time in the same position. Even if the resident is confined to a bed, they need to be rotated every hour or two, and these rotations should be marked on the resident’s medical chart.
How does the facility handle a resident’s fall?
When dealing with the elderly, falls can happen under even the best of circumstances; but it’s important to know how the staff reacts. Do they check for injuries? Do they help the resident get up off the floor safely? Is the resident checked later in the shift for injuries that aren’t apparent at first?
Is the staff overworked?
Don’t be afraid to come right out and ask the nursing assistants and other staff if they work a lot of overtime or double shifts. If so, there’s a red flag that the facility may be short-staffed which can affect the quality of patient care. Likewise, you can ask the facility director what their staff-to-patient ratio is, then compare it on the Nursing Home Compare tool at Medicare.gov. Lack of staff can increase the likelihood that the staff is overworked and overly stressed.
Finally, look for safety devices as soon as you enter the facility.
Good nursing homes want to encourage visitors so they need to keep their security measures as unobtrusive as possible while still maintaining a safe environment for their residents. Cameras and check-in systems can help keep residents safe without alarming residents. Light beams can monitor hallways or exits, and can even be used to alert the staff if a resident leaves his room. Wandering is a particular danger for people in certain stages of Alzheimer’s disease. While the facility should not feel like a prison, the residents need to be secured for their own safety. Many facilities have cleverly disguised, secure exits in their locked Alzheimer’s wings, so that the doors can’t be exited without code cards for the staff or a staff member “buzzing out” a visitor, so the wing feels more secure and less like a prison.
[If you have a question for one of our attorneys, please write it in the comments below, and be sure to check back soon for a response.]
(The information contained herein is for informational purposes only, and does not constitute legal advice.)